What to Know About Abortion Pills Post-Roe

Abortion access in the U.S. is quickly shrinking. Now that the U.S. Supreme Court has overturned Roe vs. Wade, experts predict that people will increasingly seek to end pregnancies in their homes using medication abortion (also known as a medical abortion or abortion pills). Abortion pills are already the most common way to end a pregnancy in the U.S., accounting for 54% of abortions in 2020, and that number is expected to grow.

Here’s what to know about the safety and efficacy of abortion pills.

What are abortion pills?

Medication abortions, which are approved by the U.S. Food and Drug Administration until the 10th week of pregnancy, involve taking two drugs 24 to 48 hours apart. The first one, called RU 486 or mifepristone, is a hormone that blocks progesterone and stops the pregnancy from progressing; the second, misoprostol, causes contractions and bleeding that empty the uterus.

How safe is a medication abortion?

Very safe. “We have a great deal of safety data,” says Dr. Daniel Grossman, an ob-gyn and researcher at the University of California, San Francisco. Serious complications that require hospitalizations are “incredibly rare—less than half a percent.”

Dr. Lauren Owens, an ob-gyn at the University of Michigan, adds that “medical abortion has been historically really tightly regulated because of abortion stigma, but not because of medical necessity.”

Will abortion pills remain legal now that Roe vs. Wade has been overturned?

It may become more difficult to obtain the pills, but there will be workarounds. People may still have access to medical abortions through telehealth services and mail-order pharmacies, which rely on overseas doctors and pharmacies in order to skirt U.S. regulations. Aid Access, an organization that helps people in the U.S. and around the world get access to medical abortion pills, sends the pills after patients answer a few questions on a health screening questionnaire and provide payment (usually between $200-$300); the group also offers medical guidance with international physicians over email. The pills take up to two weeks to arrive.

However, there are currently restrictions on medication abortion in 19 states requiring a clinician to be physically present when the medication is administered. Several states have also specifically outlawed mailing pills to residents of those states.

Read More: Meet the Pharmacist Expanding Access to Abortion Pills Across the U.S.

Advocates and doctors expect self-managed abortions—when someone ends a pregnancy without physician support—to increase significantly post-Roe. Examples include getting prescriptions from online pharmacies (instead of a telehealth provider) or through friends from other states. There are more risks with this method, and Robin Tucker, a nurse practitioner with Aid Access, cautions people to check carefully that the organization, company, or person sending the pills is legitimate and vetted. She recommends checking out the website Plan C, which lists trustworthy abortion-pill providers in each state. Plan C also conducts some quality control on the pills themselves.

If people need medical advice throughout the process, Tucker recommends that they call the Miscarriage and Abortion hotline: a confidential, private, and secure phone line staffed with clinician volunteers who can answer questions.

Is there a chance medication abortion won’t work?

Yes, but it’s small. Studies have shown that medication abortion is effective in ending a pregnancy between 95-99% of the time before the 9th week of pregnancy. Abortion pills gradually become less effective as the pregnancy progresses.

How do you know if abortion pills have worked?

People have to wait between four and five weeks to do a pregnancy test to make sure the pills worked. This timing puts many people past the window for medical abortion. If a woman experiences heavy bleeding and passes some tissue, then it is very unlikely she is still pregnant. But in some rare cases, the pregnancy will continue; medication abortion won’t terminate an ectopic pregnancy, for example. If someone doesn’t experience any symptoms and thinks they might still be pregnant, even after medication abortion, experts recommend that they seek medical attention and possibly have an ultrasound.

Read More: Inside the Effort to Promote Abortion Pills For a Post-Roe America

If you think you’re still pregnant, can you do another medical abortion?

Grossman says that it is reasonable to think this would work, and Tucker says she has seen some people have success on the second try. But people would need to obtain and take the second round of pills within the 10-week window, Tucker says.

Will you get in trouble if you have to seek medical care during a medication abortion?

Traditionally, abortion restrictions have targeted providers and not patients. In the case of Aid Access, providers are out of the country and therefore not at risk for prosecution. But that doesn’t necessarily mean that pregnant people aren’t legally vulnerable. Greer Donley, assistant professor at the University Pittsburgh Law School, says that not all states have protections for patients who attempt abortion. She worries that patients could be reported to authorities at the hospital, for example, if a health care provider suspects an abortion. “People are going to be scrutinized if they’re not displaying the appropriate grief response that people expect; if they are poor women of color, they are much more likely to get targeted,” she says.

Dr. Debora Bartz, an ob-gyn at Brigham and Women’s Hospital in Boston, stresses that people don’t need to tell their doctors if they did a medication abortion. “There is no way for a health care professional to be able to distinguish between a natural miscarriage or a medication abortion if the patient herself doesn’t disclose that she took these medications,” Bartz says—a point on which Grossman and Tucker both agree.

If people are worried about their legal risk, they can reach out to the free and confidential hotline called the Repro Legal helpline, which is run by If/When/How, an advocacy and support organization committed to reproductive rights. The is staffed by lawyers who can provide free legal counsel to people concerned about their risk.